One of the biggest challenges we face, especially in South Asian cultures is the overemphasis on weight as the primary marker of health
In today’s world, health is often reduced to numbers: steps walked, calories burned, hours slept. The healthcare system itself leans heavily on numerical values and formulas to assess well-being. Among these, Body Mass Index (BMI) is perhaps one of the most commonly used tools but also one of the most controversial.
A Historical Tool with Modern Consequences
BMI was developed in the 19th century by Adolphe Quetelet, a Belgian mathematician, not a physician. Originally known as the Quetelet Index, it was designed to assess population averages, not individual health. In 1972, the World Health Organization (WHO) adopted BMI as a tool for tracking obesity trends at a population level. However, despite its intended purpose, BMI has become a routine diagnostic tool used by healthcare professionals, fitness experts, and insurers worldwide to categorise individuals as underweight, normal, overweight, or obese. This widespread use, especially in individual health assessment raises serious concerns.
Why BMI Falls Short
BMI doesn’t consider important factors such as body composition, muscle mass, bone density, fat distribution, age, sex, ethnicity, or overall fitness. As a result, it paints an incomplete and often inaccurate picture of health. For example, athletes with high muscle mass may be labelled “overweight” or even “obese” by BMI standards. An older adult may be advised to lose weight based solely on their BMI, even if doing so could lead to muscle loss and increased frailty. These misclassifications aren’t just inconvenient, they can be harmful. It’s also essential to recognise that being a healthy weight doesn’t have a specific “look.” People come in all shapes and sizes, and outward appearance alone cannot determine someone’s health status. Two individuals with the same BMI may have vastly different levels of fitness, metabolic health, and risk factors. Yet the system often treats them the same, overlooking the nuances that truly matter.
The South Asian Context
In South Asia, including Sri Lanka, the use of BMI is particularly problematic. BMI cut-off points are based on European body types and were not originally designed for other populations. South Asians, for instance, are more prone to developing conditions like type 2 diabetes and cardiovascular disease at lower BMI levels.This discrepancy contributes to widespread misdiagnosis and inappropriate treatment. Many Sri Lankan doctors still rely heavily and sometimes exclusively on BMI to assess health, a trend deeply rooted in medical training and healthcare culture across the region. It’s not uncommon for patients to be told to lose weight without any further investigation, even when underlying conditions or lifestyle factors may be the real issue. Moreover, South Asians tend to store more visceral fat around internal organs like the liver or heart, which is a key risk factor for metabolic diseases. This means that someone with a “normal” BMI might still be at high risk, while the healthcare system may overlook those risks simply because their weight appears “healthy” on paper.
A More Holistic Approach
BMI can still be a useful tool at a population level it’s simple, inexpensive, and helps track public health trends. But when it comes to assessing individual health, it should never be the sole metric. A more accurate picture comes from considering a variety of factors: waist circumference, blood pressure, cholesterol, blood sugar levels, physical activity, diet, family history, age, menopause status, and smoking, among others. These indicators give a far more meaningful insight into a person’s health than number on the scale alone.
Shifting the Focus from Weight to Wellbeing
One of the biggest challenges we face, especially in South Asian cultures is the overemphasis on weight as the primary marker of health. Thinness is often equated with wellness, while those in larger bodies are frequently subjected to stigma and rushed recommendations to lose weight, even when their health markers are otherwise normal. This weight-centric approach can lead to delayed diagnoses, mismanagement of care, and deep psychological harm. It’s time we shifted the narrative. We must advocate for healthcare that supports people of all sizes, focusing on actual health outcomes rather than arbitrary numbers on a scale.
Final Thoughts
BMI is a dated, oversimplified tool that was never meant to define individual health. In countries like Sri Lanka, where its use is almost automatic, there is an urgent need to re-educate both professionals and the public. Health is multidimensional, and our approach to care should reflect that complexity.
